We require fully furnished private apartments or shared accommodation
(including all linens and kitchen equipment), available on a monthly
basis. Our clients are very independent ESL students, English
speaking students or business people. They do their own shopping
and cooking.

Please note: In a shared situation, we do not require you to
be home weekends and evenings. This is not a Homestay, you are
free to come and go as you please.

Please note: The following fields are required: Full name, address, home phone number, number of bedrooms available, and how many people you usually accommodate. Thank you. If you have a problem submitting this application, please email info@bellacc.com

1.

Name:Occupation:

Spouse:Occupation:

2.

Address:City:

Postal Code:Closest main intersection:

Tel Home:Work:Email:

Fax # Home:Office:Pager/Cell:

3.

Pets:

4.

Smoking household:
Yes
No Will you accept someone who smokes outside:
Yes
No

5.

Please indicate whether your accommodation
is:

Part of your living space. E.g. private bedroom(s), shared
kitchen, bathroom, and TV room
Completely separate. E.g. apartment or suite, with own front
door
Part of your living space but with private bedroom(s), own
kitchen, bathroom, and TV room. E.g. shared entrance, separate
floor.

6.

How many people do you usually accommodate
at one time:

7.

How many bedrooms/bathrooms do you have
for client use:

Bedrooms:Bathrooms:

8.

A) Do you have any religious beliefs/practices
you would like the client to be aware of:

B) Who will be the primary contact person with the emergency
number:

Name:Number:

9.

Travel time to downtown by public transport:

Minutes:Bus Number:

10.

Number of blocks from your home to nearest
bus stop/sky train station:

11.

How many buses would the client need
to take to get downtown:

12.

Is there a time of year when your accommodation
would be unavailable:
Yes
No

From:

To:

13.

Would you be willing to undergo a criminal
record search:
Yes
No

14.

References: (neighbours, employers, family
Doctors, teachers):

Fill out the
following questions (15-19) in a shared situation only.

15.

In a shared accommodation, please provide
name, year of birth and gender of any children living at
home:

16.

Is anyone else living in your home (e.g.
Grandparents, boarder, or roommate):

17.

Do you have preferences as to the client's
gender in a shared situation: